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The Secret to Surviving a Workers' Compensation Claim (Part 2)

The Secret to Surviving a California Workers’ Compensation Claim (Part 2)
“If you don't know where you are going, you might wind up someplace else.”
Yogi Berra

These are your objectives:
• Make sure you have the maximum cash benefit coming in while you are recovering
• Make sure you get the maximum case benefit for your Permanent Disability (PD)
• Get the medical treatment you need to get back on your feet
• Settle your claim to provide for your future medical needs
• Make sure you are taking advantage of benefits from other governmental programs

These are the benefits mandated under the California Workers’ Compensation System that can help you achieve your objectives.  Permanent Disability and Temporary Disability were covered in Part 1 of this article, The Secret to Surviving a California Workers’ Compensation Claim (Part 1).  Here in part 2 of this article I will cover what you need to know about medical treatment to achieve your objectives:

Medical Treatment
Under the California Workers’ Compensation system you are entitled to “all medical treatment necessary to cure or relieve the effects of your industrial injury” (LC Sections 4600-4603).  This includes not only doctor bills but medicines, hospital costs, fees for lab tests, x-rays, MRIs and other diagnostic procedures.  You are also entitled to costs of mileage going to and from medical appointments, trips to the pharmacy and to med-legal evaluations.

But…being entitled to medical treatment under the system and getting it are two entirely different matters.  The California Legislature gave the insurance industry draconian powers to control their costs in this department:

Multiple Provider Networks (MPNs) (think company doctor as your primary doctor).
Utilization Review (UR) (“no you can’t have this needed medical treatment as it not “evidenced based” and costs too much”).
American college of Occupational and Environmental Medicine (ACEOM) Guides (The stingy evidence based treatment protocol that UR is based on--assembled by a pack of conservative pro-insurance physicians).
Second Opinion on Spine Surgery (One of the nastiest changes of them all, you think you are going to get that needed spine surgery? Think again.)

Rest assured you can get the medical treatment you need in a workers’ compensation claim. You just have to know what you are doing.

These benefits are all about saving money for big insurance companies—beware. Now that SB-863 has been signed into law, huge changes will take place for folks injured on or after 1/1/13, but more on that in following articles.  

Future medical treatment
If you settle your case on “stipulation,” you keep your rights to future medical treatment open for life.  Sadly though, keeping your medical treatment rights open sometimes only gives you the right to fight for future medical treatment as such treatment is subject to the above issues.  But, if you have no better alternative, it is better than no treatment at all. 

Job Displacement Vouchers
Another cruel joke played on injured men and women in this state was the elimination of the Vocational Rehabilitation Program back in 2003. Back in the good old days, workers that could not return to their old jobs had a simple retraining program available to them to get back into the work force.  Now we have Job Displacement Vouchers.  For injuries prior to 1/1/13, Vouchers range from $4,000.00 to $10,000.00 depending on an applicant’s level of disability. For in 2013 Job Displacement Vouchers are a flat $6,000.00.

Helpful Hint: It is all about educating yourself – quickly.  You will discover some very, very thoughtful directions on the specifics of a workers’ compensation claim going to the California Department of Industrial Relations website (dir.ca.gov) and selecting the “Workers Compensation” tab and start researching. No one said this is going to be easy.



Thomas Ledgerwood
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Proprietor Ledgerwood Law Group